title: Outcomes of feeding problems in advanced dementia in a nursing home population.
abstract: OBJECTIVE
  To describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Twenty-four nursing homes (NHs).
  
  
  METHODS
  Nursing home residents with advanced dementia and feeding problems and family surrogates (N = 256).
  
  
  METHODS
  Family reported on quality of feeding care at enrollment and 3 months. Chart reviews at enrollment and 3, 6, and 9 months provided data on feeding problems, treatments, weight loss of more than 5% in 30 days or more than 10% in 6 months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data.
  
  
  RESULTS
  Residents with advanced dementia and feeding problems had an average age of 85; 80% had chewing and swallowing problems, 11% weight loss, and 48% poor intake. Family reported feeding assistance of moderate quality; 23% felt the resident received less assistance than needed. Mortality risk was significant; 8% died within 3 months, 17% within 6 months, and 27% within 9 months. Residents with advanced dementia who had stable weight over 3 months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3 months. Residents with advanced dementia and weight loss over 3 months had a 38.9% chance of stabilizing weight over the next 3 months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death.
  
  
  CONCLUSIONS
  Weight loss is a predictor of death in advanced dementia. Treatments can often stabilize weight, but weight loss should be used to trigger discussion of goals of care and treatment options.
authors.affiliation: Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina; Center for Aging and Health, University of North Carolina, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
authors.forename: Feng Chang
authors.initials: FC
authors.lastname: Lin
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
mesh_terms: D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications* / Q000401:mortality; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D015596:Nutrition Assessment; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
keywords: dementia; nursing home; nutrition